Floor 710 james robertson parkway nashville, tennessee 37243 Ryan White Part b services

The purpose of this policy is to establish eligibility guidelines and procedures to be utilized when registering and recertifying clients for Tennessee Ryan White Part B assistance programs.

1. 
   To be deemed eligible for coverage by Ryan White Part B Services programs a recipient must meet the following criteria:
   

1. 
   The recipient must have been diagnosed with HIV/AIDS.
   
2. 
   The recipient must be a resident of Tennessee.
   
3. 
   The recipient must meet the income guidelines established by the program: maximum gross monthly income for the legal household unit is less than or equal to 400% of the current Federal Poverty Level*.
   

2. 
   Eligibility is further based upon the applicant’s willingness to work with his/her Medical Case Manager (MCM) to apply for all other possibilities of third party coverage (i.e., TennCare, group coverage through an employer, Veterans Administration (V.A.), etc.). Clients must keep MCM informed of a current address and phone number, if available. Persistent failure to cooperate in applying for alternate programs, keeping contact information current, or failure to take medications as prescribed for two consecutive months, is grounds for termination / suspension from all Ryan White Part B Services Programs.
   

3. 
   Applicants who have Health Insurance (including TennCare) that provides HIV medications, may not receive pharmacy services from HDAP or medical services through the Medical Services Program, while eligible for those services under their policy. Premiums, co-pays and deductible payments may be made under the Insurance Assistance Program, for private health insurance clients and TennCare clients, for policies that have uninterrupted coverage.
   

4. 
   Record Keeping Requirements - A separate case file must be maintained on each client, containing the following:
   
   1. 
      PH- 3716, Ryan White Program Application
      
   2. 
      Documentation of HIV status, viral loads and CD4
      
   3. 
      Proof of current Tennessee residency
      
   4. 
      Proof of current income
      
   5. 
      Photo identification of client
      
   6. 
      Household Addendum Form, if applicable
      
   7. 
      PH-4266 Insurance Assistance Plan Application, if applicable
      
   8. 
      Oral Health/Dental Assistance Program Application, if applicable
      

1. 
   All clients must be evaluated for eligibility by a Medical Case Manager when the initial application is submitted to the Ryan White Part B Program.
   

2. 
   All clients must be recertified every 6 months (per HRSA policy).
   

3. 
   A recertification application must be sent to Tennessee Department of Health, Ryan White Part B Program via the Ryan White Eligibility System.
   

4. 
   Recertification should occur on, or close to, the client’s last full certification date, and approximately six (6) months later.
   

5. 
   Clients can recertify using the Ryan White Part B Six Month Self-Attestation Form.
   

6. 
   Recertification may occur ninety (90) days prior to the recertification due date. The next certification must be a full certification and will be due in six (6) months.
   

7. 
   If a recertification form is not received by the due date, the client will be disenrolled, and the pharmacy will be notified that the client is no longer on the program.